Hi. I occasionally run into a situation where a patient has an implanted port, but needs more lumens. I would like some input on whether it's better to give the patient a multilumen PICC and deaccess the port, or leave the port accessed and limit the lumens on the PICC, say, to even a single?
We have had several incidents in which a port patient needed additional access. We left the port accessed and place either a single or dual lumen in the patient. We currently have a patient in our ICU who has both, plus a PIV, as he has 5 continuous IV's infusing. We have not encountered any issues at present.
Mally Harman, RN, BSN
Mally Harman, RN, BSN
Vascular Access Team Coordinator
Centra Health
Lynchburg, VA
434-200-2647
The issue in this decision is not whether or not the implanted port is or is not being used for infusion. The issue is the amount of intraluminal space inside the vein taken up by the presence of catheters. More catheter material - length and diameter - inside the vein lumen, the greater risk of thrombosis. You can use a small OD PICC with 1 or 2 lumens. You can place the PICC from the extremity opposite the port. Can some of the therapy be infused through a midline catheter? Use the nursing process to assess the patient needs and choose the approach that is the least risk and best benefit for that patient. Again, there can be no blanket rules that applies to every patient. Correct tip location, adequate stabilization, and correct hub management for all lumens will also be critical when the number of catheters increases. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
In ICU settings, we often place triple lumens and have a port accessed if that meets the patient's needs, it is prudent to choose a continuous infusion to the port so to minimize the 'connect and disconnect and connect' to the port clave, minimizing the risk of introducing bacteria to the port which is hopefully in implanted for the long haul as opposed to the PICC which will can be removed if the patient shows s/s infection.